We’ve just been asked if there could be any ulterior motive behind an unhelpful care home manager suddenly wanting to take a resident with severe dementia (Mrs P) to a Christmas pantomime.

It’s an unusual question, and our answer may sound cynical, but we’ve heard too many cases of maladministration in the care funding assessment process to advise anything other than caution…

Mrs P’s family is in the middle of applying for NHS Continuing Care funding to cover her care fees. It’s been a tortuous process to date, and the care home manager has been very reluctant to help. Plus, it’s taken over a year so far just to get through the first stage.

It would almost certainly be traumatic for someone with advanced dementia to be taken to a noisy, chaotic pantomime, and so could there be a hidden agenda behind the care home manager’s desire for Mrs P to go?

Generally speaking, a care home gets paid more per week directly from the resident than it does if the NHS is paying. So if Mrs P’s family succeeds in securing NHS Continuing Care funding for her, the care home will lose out financially. There is a clear conflict of interests.

To protect its revenue, one option for the care home is to ensure the daily care notes for Mrs P show that her health needs are not as bad as the family makes out – and that she is more able that previously thought. In Mrs P’s case it certainly sounds as though the care home manager is aware of that – and so anything that is subsequently mentioned in the daily care notes about a Christmas outing and about how much Mrs P ’enjoyed it’ will certainly count against Mrs P when the NHS reviews those care notes for funding purposes.

So be cautious. It’s a pity that families have to look at potential ulterior motives in issues like this because, of course, there are many helpful care home managers out there.

Our advice to Mrs P’s family was to stop the care home taking Mrs P to the pantomime – and to explain their reasons purely from a dementia point of view. Plus, we suggested they ask the care staff to write those reasons in Mrs P’s daily care notes, to emphasise that her cognitive impairment prevents her being able to join in such events – all of which is perfectly true.

7 Comments

My relative’s Continuing Healthcare checklist had been completed in advance of me meeting the person completing it, the Patient Flow Manager, so clearly she wanted my relative out asap and knew that if she failed the checklist she would be the responsibility of Social Services to sort out, quicker and easier than the Continuing Healthcare route. I was not allowed to see the form, or what had been written. It was immediately obvious that many health problems (advised in writing) had been left out altogether. I refused to sign the form as I was sure it was incorrect. DO NOT SIGN ANYTHING if you are unhappy with it. After another meeting at the hospital, it has been agreed that an entirely new checklist form should be completed.

I too would be extremely cautious in allowing a relative to go on an outing during an application for NHS Continuing Care funding. My relative has been living in a nursing home for 5 years, during which time she has been shopping once. I have repeatedly offered to take her again, when I thought she might be well enough to go, but she has declined The evening before my relative’s DST Meeting I received a call from the Lead Nurse Assessor during which she advised me that my relative desired to go shopping with me. She mentioned this again during the DST meeting. I am now very suspicious as to why she placed such emphasis on this matter. It was as if she wanted me to commit to doing so and she could then use this information to play down my relative’s health needs The MDT concluded that my relative did not qualify for NHS Continuing Care funding.

If a family believes that the nurses involved did not conduct an MDT meeting correctly and that they were unsympathetic towards the elderly in general is there any thing to be achieved from reporting them to the RCN?

That certainly does sound very suspicious. You could certainly raise it with the RCN. Keep in mind at the same time, though, that you’re relative is in the care of the nurses you may be complaining about. Of course, you shouldn’t have to think that way, but it’s just something to bear in mind. The whole situation is appalling for families.

I am interested to see that care homes get paid more by the resident than it does if the NHS is paying. Since I believe that the resident will still be responsible for the payment of their board and lodging, perhaps care homes should be required to itemise their bills to clarify which part is for nursing care and which for board and lodging so that the shortfall cannot be recouped by transferring it to board and lodging.

Your information about Mrs P going to a pantomime is very intresting. My mum has just been given th oppertunity to go to a garden centre next week for which I was pleased for her but after reading your experance of the pantomime I am not so sure this is a good move.
We applied for NHS continuing Healthcarefunding in September and ths is the first time the nursing home has offered to take her out after being in this nursing home for about 18 months. Mum has a very complex illness and anyone will find it difficult and hard work to take her out.

Many thanks for your comment. A garden centre should certainly be a calmer environment than a pantomime, but it’s interesting that the home should be offering to take her out now, after all this time. Many families complain that care homes don’t ever take their relative out, and so any genuine initiatives to do this should of course be applauded. The key is to identify what the motive behind it might be. If you’re able to, it might be a good idea to go with her perhaps, and then care staff will know you’re observing just how difficult it is, and you can report this back in any later arguments with the NHS about funding.

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